The Innovative Therapist

Episode 12. Today on the podcast, I got to talk to my very dear friend and incredibly talented colleague Dr. Sapna Doshi.

Dr. Sapna Doshi is a licensed clinical psychologist and owner of Mind Body Health. Dr. Doshi earned her Ph.D. from Drexel University and completed her internship at Duke University Medical Center. In 2015, she opened her private practice, Mind Body Health which now operates in Arlington, VA and Washington, DC and is staffed with 25 psychologists and dietitians. Mind Body Health specializes in providing evidence-based treatment in the areas of eating disorders, insomnia, obesity, chronic pain, anxiety disorders, and mood disorders. 

What We Cover

What is the field of clinical health psychology doing well?Where are we missing the mark?How can people balance working on improving their relationship to food and their bodies when they have difficulty letting go of weight loss as a goal?

Health at Every Size and Intuitive Eating

Dr. Doshi talks about the positive effects of the Health at Every Size movement and Intuitive Eating as an alternative approach.

We also discuss a controversial topic which is the effect she and I have seen where some members of a social movement can come across as shaming to others.

She talked about the environment she has created within her practice where they can have conversations between professionals that are respectful, even if they ultimately disagree. This has created a community where collaboration and focus on the client remains the top priority.

Striking the Balance Between External Suggestions and Internal Cues

Dr. Doshi talks about the balance and difficulty of this in the real world. She discusses her own personal experience with having a diagnosis of small intestinal bacterial overgrowth (SIBO) and how challenging it is to tune inwards while having to avoid certain foods she enjoys.

Considerations for the Body Mass Index in South Asian Community

Dr. Doshi talks about her experience as a South Asian woman growing up in the United States. We also talk about her dissertation research and the fact that South Asian women on average actually have higher body fat percentage at a lower body mass index (Doshi, 2012). So again we see the limitations of the body mass index in actually predicting health.

She also discussed a finding from her dissertation that more cultural conflict (that is, more conflict between the South Asian and standard American culture) was associated with higher levels of disordered eating (Doshi, 2012).

Ways to Improve Cultural Adaptations to Improve Care

Dr. Doshi shares a story of her experience being told how to treat her SIBO and the lack of cultural adaptation and flexibility in the standard medical approach.

She also shares about the fact that South Asians are underrepresented in the mental health field. Therefore, it's important to work towards increasing diversity in different health professions.

Why Does Behavioral Weight Loss so Often Fail?

We talked about our experiences with behavioral weight loss trials, and ways in which we were part of methods that were ultimately rarely successful long-term.

"Deprivation is not a state we can constantly be living in."Dr. Sapna Doshi, PhD

She also discusses the fact that prior weight loss attempts can sometimes be romanticized, leaving people to forget the negative and focus on all the positive (e.g., "I think I was happy... I must have been, I was thin!")

Is Long-Term Weight Loss Possible? What Do We Know?

We talked about the National Weight Control Registry. This is a registry for people who have lost at least 30 pounds and kept it off for at least a year, though on average they have lost more weight and kept it off longer than that (Thomas et al., 2014).

What Have We Learned from this Registry?

Regularly activeModifying their eating in some wayMost eat breakfast regularlyThey aren't watching a ton of television

What are We Not Considering When We Look at These Folks?

Are they obsessing about food and preoccupied with it?Are they depressed or anxious?How is their quality of life?

We want to be incredibly cautious generalizing the findings from this research. That is, first the sample is incredibly small and there are many reasons to question whether this could apply more than a small subset of folks. Additionally, more research is needed before we can truly understand if folks are really feeling freedom and peace with their relationship with food before we glorify this outcome as "success" just because they are maintaining some degree of weight loss.

Let's Talk Outcomes

We talked about how rare it is for us to work with folks who lose a significant amount of weight and keep it off in her individual work. She talks about her focus on helping people navigate their relationship with food and their body and viewing weight loss as more of a secondary outcome or byproduct of their work together.

We cover the following strategies:

Challenging all-or-nothing thinkingMaking goals of cooking more at home, but not in an all-or-nothing way and having more control over what you put into your bodyStress managementAvoiding meal skippingLooking for ways to enjoy the processFinding ways to cope with emotions other than eating

Themes for What Works

Less restriction, what to addMore flexibility and sustainabilityLess deprivationFocused on learning and growth

How to Turn a Should to a Want To

We talked about how Sapna turned staying on top of her work from a "should" to a "want to."

Tackling the task and confront avoidanceMoving away from perfectionismShifting from thinking "I should do this" to "I want to do this because it will make me feel better." Integrated into her value to take care of herself and have more freedom and joy, not less

References

Doshi, S. (2012). An Investigation of Motivations Associated with Eating and Weight Concerns Among South Asian and European-American Young Adults. [Dissertation, Drexel University].

Thomas, G. Bond, D. S., Phelan, S., Hill, J. O., Wing, R. R. (2014). Weight-Loss Maintenance for 10 Years in the National Weight Control Registry. American Journal of Preventive Medicine, 46, 17-23.

Disclosure: This page includes affiliate links meaning that I get a commission if you decide to make a purchase through my links, at no cost to you. I have not received any money to promote or review these products.

Disclaimer: This blog and podcast is for informational and educational purposes only. It is not a substitute for individual professional advice or treatment, including medical or mental health advice. It does not constitute a provider patient relationship.

Episode 12. Today on the podcast, I got to talk to my very dear friend and incredibly talented colleague Dr. Sapna Doshi.

Dr. Sapna Doshi is a licensed clinical psychologist and owner of Mind Body Health. Dr. Doshi earned her Ph.D. from Drexel University and completed her internship at Duke University Medical Center. In 2015, she opened her private practice, Mind Body Health which now operates in Arlington, VA and Washington, DC and is staffed with 25 psychologists and dietitians. Mind Body Health specializes in providing evidence-based treatment in the areas of eating disorders, insomnia, obesity, chronic pain, anxiety disorders, and mood disorders. 

What We Cover

* What is the field of clinical health psychology doing well?* Where are we missing the mark?* How can people balance working on improving their relationship to food and their bodies when they have difficulty letting go of weight loss as a goal?

Health at Every Size and Intuitive Eating

Dr. Doshi talks about the positive effects of the Health at Every Size movement and Intuitive Eating as an alternative approach.

We also discuss a controversial topic which is the effect she and I have seen where some members of a social movement can come across as shaming to others.

She talked about the environment she has created within her practice where they can have conversations between professionals that are respectful, even if they ultimately disagree. This has created a community where collaboration and focus on the client remains the top priority.

Striking the Balance Between External Suggestions and Internal Cues

Dr. Doshi talks about the balance and difficulty of this in the real world. She discusses her own personal experience with having a diagnosis of small intestinal bacterial overgrowth (SIBO) and how challenging it is to tune inwards while having to avoid certain foods she enjoys.

Considerations for the Body Mass Index in South Asian Community

Dr. Doshi talks about her experience as a South Asian woman growing up in the United States. We also talk about her dissertation research and the fact that South Asian women on average actually have higher body fat percentage at a lower body mass index (Doshi, 2012). So again we see the limitations of the body mass index in actually predicting health.

She also discussed a finding from her dissertation that more cultural conflict (that is, more conflict between the South Asian and standard American culture) was associated with higher levels of disordered eating (Doshi, 2012).

Ways to Improve Cultural Adaptations to Improve Care

Dr. Doshi shares a story of her experience being told how to treat her SIBO and the lack of cultural adaptation and flexibility in the standard medical approach.

She also shares about the fact that South Asians are underrepresented in the mental health field. Therefore, it's important to work towards increasing diversity in different health professions.

Why Does Behavioral Weight Loss so Often Fail?

We talked about our experiences with behavioral weight loss trials, and ways in which we were part of methods that were ultimately rarely successful long-term.

"Deprivation is not a state we can constantly be living in."Dr. Sapna Doshi, PhD

She also discusses the fact that prior weight loss attempts can sometimes be romanticized, leaving people to forget the negative and focus on all the positive (e.g., "I think I was happy... I must have been,

Episode 11. Today's episode I dive into 3 tips to improve your relationship with food that you may not have considered.

Free Resources Mentioned in this Episode

Anti-Diet Pep Talk: Struggling to regain control of your eating? Grab this audio guide to walk you through the steps to regain control and get in touch with your body in an anti-diet way.

1. Consider Your Environment, But Not in the Typical Way

Yes, our food environment 100% matters. However, I want to talk about your social environment. You often hear me talk about autonomy as a key psychological need for long-term habit change.

My question for you is, is your environment supporting your autonomy? Or is it consistently thwarting it?

Have the Conversations with a Plan

I often talk to folks who are in relationships where they don't feel free to be themselves, or they feel constantly criticized or judged for their decisions, food or otherwise.

If you have people in your life playing the "food police" and you haven't taken the time to calmly explain to them why it's unhelpful, now is a great time to do so. Even if they don't change their behavior, you have calmly asserted yourself and given yourself the message that your feelings matter, as does your autonomy.

I also often talk to folks about assertive communication. Assertive communication often gets confused with aggression or confrontation. But assertiveness is actually the exact opposite of this. It's communicating in a way that's respectful of the other person and of yourself.

It isn't blaming or shaming, but simply stating the facts based on your experience.

Assertive Communication Example

Instead of angrily saying, "that isn't helpful! You are just making things worse!" you could try something like:

"When you comment on my eating, it makes me feel self-conscious and anxious. It would be more helpful if you could not say anything." or "I have a hard time not judging myself and trusting my body and it's important for me to learn to do this. I know you think you are helping, but the best way to help is to [help me plan the meals at the beginning of the week]" (Or enter in whatever would be helpful to you).

As essential component of gaining autonomy is having the freedom of choice without excessive pressure to behave in a certain way.

I recently did a podcast interview with Annyck Besso, MA, RD, a registered dietitian with a master's in dietetics and we talked all about Health At Every Size and some of the myths about it. Although with any community and social movement there can be polarized views, the messaging is that fat and body size acceptance is a way to decrease the focus on weight and size as the sole measure of health, and broaden the circle to what actually impacts health.

2. Recognize Where the Lack of Trust Comes From

"But Shawn, I can't control myself with food. Look at how often I'm binge eating."

Often, this lack of trust truly comes from being physiologically undernourished. It also often is caused by repeated dieting even at calorie levels that we have been told for years is "healthy" (e.g., 1200 calories, 1500 calories).

In a few more week's my podcast interview with Annyck Besso, MA, RD will come out and we debunk the myth that 1200 calories is "enough" food.

Additionally, it can come from years of feeling that (and often being told that) you "failed" because you failed to lose weight and keep it off (like 95% of others as well, yet most often we blame ourselves).

3. Speak Your Shame (in Trusted Places)

There is a reason so many people eat in response to stress. When I ran my group called the "Healthy Living Group" it was often also called the stress eating group. I have never had so many people self-disclosure that they needed my group. Often in a joking way, but stress eating is incredibly common.

The more I do this work and reflect on how we are doing as a field and on my personal experience and work with clients, I realize that a HUGE driver of eating and weight difficulties is shame. I sometimes use that term with clients. While some totally agree, some are a big skeptical.

"I'm not ashamed of myself, I just need to lose weight."

It's More Than Just the Strategies

I love research, evidence-based practice and strategies. They are important, and they often work. However, when your relationship with food is so steeped in shame, it can be hard to break through some of the rigid beliefs about self-worth to really experience self-trust and autonomy as mentioned above.

As hard as it is, reaching out, sharing with trusted people in your life and/or professionals is an essential component. We are social beings are meant to be connected. We will judge each other, it's what we do, but we have to work to become aware of this pattern and break it. Or apologize when we mess up.

The more I work in this space of health, weight, body size, body shame, the more I realize how polarized we are. I judge too, and I get judged. I'm biased and so are you. BUT, we can catch ourselves and work to improve. There's SO much to be learned here.

3 Unexpected Ways to Improve Your Relationship to Food

Consider your social environment. Take an honest look here and consider what you might not be considering. Then, can you make a change. Sometimes this requires assertive communication, other times it may mean ending or changing relationships that aren't serving you. Recognize the source of the lack of trust. Are you assuming you are out of control and there is something wrong with you and discounting the system? Are you discounting that you might be underfed. This is where working with a trust professional can be incredibly helpful. Speak your shame (in trusted places). This is a big deal. Whether or not you struggle with significant binge eating or depression, or just more mild dissatisfaction with your weight and occasional binge eating, we all have shame. We all have stuff. When we say we don't, it's serves no one. Definitely not ourselves. Speaking your shame and becoming vulnerable is hard, but so incredibly powerful. And also can be incredibly freeing, at least in my experience. ;)

Disclaimer: This podcast is for informational and educational purposes only and are not a substitute for individual professional advice or treatment, including medical or mental health advice. Additionally, this podcast and any information provided by me on my website does not constitute a provider patient relationship.

Episode 11. Today's episode I dive into 3 tips to improve your relationship with food that you may not have considered.

Free Resources Mentioned in this Episode

Anti-Diet Pep Talk: Struggling to regain control of your eating? Grab this audio guide to walk you through the steps to regain control and get in touch with your body in an anti-diet way.

1. Consider Your Environment, But Not in the Typical Way

Yes, our food environment 100% matters. However, I want to talk about your social environment. You often hear me talk about autonomy as a key psychological need for long-term habit change.

My question for you is, is your environment supporting your autonomy? Or is it consistently thwarting it?

Have the Conversations with a Plan

I often talk to folks who are in relationships where they don't feel free to be themselves, or they feel constantly criticized or judged for their decisions, food or otherwise.

If you have people in your life playing the "food police" and you haven't taken the time to calmly explain to them why it's unhelpful, now is a great time to do so. Even if they don't change their behavior, you have calmly asserted yourself and given yourself the message that your feelings matter, as does your autonomy.

I also often talk to folks about assertive communication. Assertive communication often gets confused with aggression or confrontation. But assertiveness is actually the exact opposite of this. It's communicating in a way that's respectful of the other person and of yourself.

It isn't blaming or shaming, but simply stating the facts based on your experience.

Assertive Communication Example

Instead of angrily saying, "that isn't helpful! You are just making things worse!" you could try something like:

"When you comment on my eating, it makes me feel self-conscious and anxious. It would be more helpful if you could not say anything." or "I have a hard time not judging myself and trusting my body and it's important for me to learn to do this. I know you think you are helping, but the best way to help is to [help me plan the meals at the beginning of the week]" (Or enter in whatever would be helpful to you).

As essential component of gaining autonomy is having the freedom of choice without excessive pressure to behave in a certain way.

I recently did a podcast interview with Annyck Besso, MA, RD, a registered dietitian with a master's in dietetics and we talked all about Health At Every Size and some of the myths about it. Although with any community and social movement there can be polarized views, the messaging is that fat and body size acceptance is a way to decrease the focus on weight and size as the sole measure of health, and broaden the circle to what actually impacts health.

2. Recognize Where the Lack of Trust Comes From

"But Shawn, I can't control myself with food. Look at how often I'm binge eating."

Often, this lack of trust truly comes from being physiologically undernourished. It also often is caused by repeated dieting even at calorie levels that we have been told for years is "healthy" (e.g., 1200 calories, 1500 calories).

In a few more week's my podcast interview with Annyck Besso, MA, RD will come out and we debunk the myth that 1200 calories is "enough" food.

Additionally, it can come from years of feeling that (and often being told that) you "failed" because you failed to lose weight and keep it off (like 95% o...

Episode 10. I get asked often about my nutrition background. While I have extensive training in psychology and behavior change, my nutrition training is mostly self-study. I did do a 6-week online Plant-Based Nutrition Certification at Cornell University and have read a lot of nutrition books, but I am certainly not a dietitian or trained in the ins and outs of nutrition. I'm also not a physician.

For this reason, I rely heavily on my esteemed nutrition and medical colleagues to help us understand the evidence for nutrition and how we can apply it in our lives.

Today, I had the pleasure of interviewing my colleague and friend Holly Dykstra, MA, RD, who has her Bachelor's of Science and Master's of Arts in dietetics from Western Michigan University and has worked as a registered dietitian since 2008 in many different hospital-based settings, most recently Preventive Cardiology and Cardiac Rehabilitation where she and I worked together at my previous job.

Free Resources

Are you struggling to control your eating or feeling stressed about weight gain? Download my free audio guide which walks you through the simple steps of the HOW of anti-dieting. It helps you tune in to your body and make the next positive empowered choice for yourself and your body. Grab that here!

Plant-Based, Vegan, Vegetarian, Mediterranean, Oh My!

We start by breaking down some of the differences in plant-based diets, Mediterranean diets, vegan diets and what some of the evidence says about the impact of these diets on disease risk. These diets can all fall in the category of "plant-forward" meaning they emphasize plants heavily, but not necessarily exclusively.

We dicuss the fact that the Mediterranean diet is very well studied with 5-10 year follow up data. Interestingly, this diet is often more of an overall lifestyle so we can't fully separate the "what people are putting in their mouths" with other health-related factors like being physically active, strong social connections, regular relaxation and self-care behaviors, and so on.

"Plant-Forward" diets have strong evidence for:

Reducing inflammation (reduction in C-Reactive protein, a marker of inflammation - a nutrient dense vegan diet appears to have the strongest evidence for this effect)Reducing cognitive decline (Mediterranean diet appears to have the strongest evidence for this effect)Among other impacts on reduced disease risk like reduced heart disease, cancer, diabetes, etc

Differences Between Eating Patterns Were Relatively Small

We talked about the fact that differences between the above eating patterns were relatively small. Notably, the samples were smaller for the studies of vegan or vegetarian diets. Not surprisingly, stronger health outcomes are found in more nutrient dense diets versus nutrient poor. That is, you could eat a vegan diet and still eat a lot of processed foods (processed vegan meats, snacks, etc), which would have less of a positive effect on your health than eat whole foods close to their "natural state".

Types of Carbohydrate Matters a Lot

Holly talked about a study by Satija and colleagues (2017) where they found that when refined carbohydrates (e.g., juice, french fries, desserts) were swapped out for foods like fruits and vegetables and whole grains and saw improved cardiac outcomes.

So remember, eating more whole foods and fewer processed foods matters. Plant-based does not just need to be taken as "eat less meat."

What about Plant Forward Diets (Vegan, Vegetarian, and Mediterranean) and Weight Loss?

Although I'm not a proponent of focusing on weight loss as the driving factor as I think it can backfire, inquiring minds want to know, do these eating styles impact weight loss? Particularly, I was interested in talking to Holly about long-term outcomes, like 4-5 years.

The answer is yes these eating patterns are associated with weight loss, with a caveat. Most of the large long-term scale studies were done in individuals with relatively lower starting weights, like the Mediterranean diet study. These folks lost 10-20 pounds on average and were able to maintain this for a longer period of time (Martinez-Gonazlez, Gea, & Canela, 2019).

There are some more intensive interventions that show larger impacts for folks starting at higher weights, but we need more research here. However, there is promise for these eating styles greatly reducing and even reversing disease even starting at more progressed disease or higher weights.

Why Isn't Nutrition's Impact on Disease Risk More Widely Discussed?

I asked Holly her opinion about why more people weren't given information regarding nutrition and how powerful it can be in terms of reversing disease risk. She talked about the fact that physicians get a lot of training in a lot of areas but very little nutrition training in their standard medical school curriculum.

She also talked about how it can be challenging for folks to integrate nutrition information alongside standard medical treatments because it can be overwhelming for folks.

Additionally, we talk about the mixed messages we can be bombarded with on social media and this can create some "analysis paralysis" where people just don't know what to believe.

What about the Ketogenic Diet or Intermittent Fasting?

Holly gives a brief overview of the ketogenic diets and intermittent fasting and the research there.

She expressed that the main concern with the ketogenic diet is that it limits carbohydrates to 10-20% of our calories, which is low compared to a typical Mediterranean diet being closer to 40-60%. This does not give a lot of space for fruits and vegetables which could be problematic depending on what folks are actually eating within this pattern.

We talk about the research here and how we see some effects of ketogenic diets within 3-6 months (weight loss, improved blood sugars, and lipids) but we don't have the long-term data right now. She also talks about how a lot of those effects might be general improvements in eating patterns and just the impact of the short-term weight. But overall, we just don't have much long-term data here.

We discuss intermittent fasting (this could involve limiting eating to certain hours of the day) and how there may be some short-term benefits here too (some reduction in inflammatory markers, some weight loss), but we have limited longer-term data as well. She talked about the importance of making sure that people get enough nutrition in in the windows they are eating.

Plant-Based Keto?

We briefly touch on this, and Holly shares that there is some promising data here as you are typically replacing saturated fat with unsaturated fats and can see reduced LDL.

She also talked about a study that showed that replacing saturated fats with either unsaturated fats or with whole grains both showed improvements in heart disease risk (Zong, Li, Yanping, Wanders, et al., 2016). So there are different ways to improve health via nutrition, but the emphasis is usually on less saturated fat, more whole foods, and reduced processed foods.

What is the Summary? What Do We Really Know about Nutrition?

Here's my take on the big picture pieces of what we know about evidence-based nutrition:

More whole foods, more plants (fruits, veggies, whole unprocessed grains) are very nutritious and healthful.There is good data on plant-forward diets (whole food plant-based, vegetarian, vegan, Mediterranean style eating pattern) in terms of reducing disease risk and some weight loss though these weight losses don't tend to be incredibly large (at least not in the larger and longer-term studies of over 5 years). More whole foods (foods in their natural form, not protein bars or something created in a food lab) is important. A vegan diet can be unhealthful if it's full of processed foods, so moving away from nutrient poor foods and towards nutrient dense foods is helpful.Focusing on weight loss very often undermines focus on what truly impacts our health, like more nutritious quality foods. For most people, giving up all animal products does not seem to be necessary to gain significant health benefits.

Let's Look at the Whole Picture

I mentioned that I'm reading the book Whole: Rethinking the Science of Nutrition by T Colin Campbell. This book talks about how we use a "reductionist" view of nutrition and how this is harmful and gets us caught up in the weeds and distracted from some of the big picture things we do know about our health and nutrition.

How to Use this Information in an Anti-Diet Way

Reflect on Your Goals. We talked about ways to focus on your individual health goals, reduce focus on weight loss, and shift the focus to realistic and sustainable habits. One way to do this is to consider eating patterns an experiment and just pay attention to how you feel on that specific eating pattern.Add in Versus Take Out. We also talked about the benefit of focusing on what to add in versus what to restrict. Don't stress too much about the shoulds, but just look for places where you could add more fruits and vegetables into your diet or more whole foods and stressing less about what you "shouldn't" be adding. Holly recommends adding in soluble fibers, which comes from plants. Start Small if Overwhelmed. Start with 1 simple change and build from there. Try 1 plant-based meal. I use the Forks Over Knives meal planner and I think it's a great place to start (and free for the first 14 days). You do not have to overhaul things if you don't feel ready. You are the boss of you and you get to do what works for you at this point in your life. You have choice, my friends. Re-evaluate and Assess and Build from There. If you do try experiments (with approval by your medical professional of course) with your eating pattern, just evaluating, did I feel healthier? Did this move me towards my goals?Enjoy the Process....

Episode 10. I get asked often about my nutrition background. While I have extensive training in psychology and behavior change, my nutrition training is mostly self-study. I did do a 6-week online Plant-Based Nutrition Certification at Cornell University and have read a lot of nutrition books, but I am certainly not a dietitian or trained in the ins and outs of nutrition. I'm also not a physician.

For this reason, I rely heavily on my esteemed nutrition and medical colleagues to help us understand the evidence for nutrition and how we can apply it in our lives.

Today, I had the pleasure of interviewing my colleague and friend Holly Dykstra, MA, RD, who has her Bachelor's of Science and Master's of Arts in dietetics from Western Michigan University and has worked as a registered dietitian since 2008 in many different hospital-based settings, most recently Preventive Cardiology and Cardiac Rehabilitation where she and I worked together at my previous job.

Free Resources

Are you struggling to control your eating or feeling stressed about weight gain? Download my free audio guide which walks you through the simple steps of the HOW of anti-dieting. It helps you tune in to your body and make the next positive empowered choice for yourself and your body. Grab that here!

Plant-Based, Vegan, Vegetarian, Mediterranean, Oh My!

We start by breaking down some of the differences in plant-based diets, Mediterranean diets, vegan diets and what some of the evidence says about the impact of these diets on disease risk. These diets can all fall in the category of "plant-forward" meaning they emphasize plants heavily, but not necessarily exclusively.

We dicuss the fact that the Mediterranean diet is very well studied with 5-10 year follow up data. Interestingly, this diet is often more of an overall lifestyle so we can't fully separate the "what people are putting in their mouths" with other health-related factors like being physically active, strong social connections, regular relaxation and self-care behaviors, and so on.

"Plant-Forward" diets have strong evidence for:

* Reducing inflammation (reduction in C-Reactive protein, a marker of inflammation - a nutrient dense vegan diet appears to have the strongest evidence for this effect)* Reducing cognitive decline (Mediterranean diet appears to have the strongest evidence for this effect)* Among other impacts on reduced disease risk like reduced heart disease, cancer, diabetes, etc

Differences Between Eating Patterns Were Relatively Small

We talked about the fact that differences between the above eating patterns were relatively small. Notably, the samples were smaller for the studies of vegan or vegetarian diets. Not surprisingly, stronger health outcomes are found in more nutrient dense diets versus nutrient poor. That is, you could eat a vegan diet and still eat a lot of processed foods (processed vegan meats, snacks, etc), which would have less of a positive effect on your health than eat whole foods close to their "natural state".

Types of Carbohydrate Matters a Lot

Holly talked about a study by Satija and colleagues (2017) where they found that when refined carbohydrates (e.g., juice, french fries, desserts) were swapped out for foods like fruits and vegetables and whole grains and saw improved cardiac outcomes.

So remember, eating more whole foods and fewer processed foods matters. Plant-based does not just need to be taken as "eat less meat."

What about Plant Forward Diets (Vegan, Vegetarian, and Mediterranean) and Weight Loss?

Episode 9. Today's episode is all about how to shift a habit from a "should" to a "want to."

Free Resources Mentioned in this Episode:

23 Positive Things to do Besides Eating: A list of 23 quick ideas, with links, most 100% free!

Back on Track Pep Talk: Struggling to regain control of your eating without dieting? Grab this audio guide to walk you through the steps.

Autonomy is the Jam

As someone who worked for years trying to help people lose weight, the stats are simply not inspiring. The cool thing is, we do understand a lot about what TYPE of motivation facilitates long-term behavior change and even weight loss maintenance.

When women participating in a health program had autonomous motivation for exercise, they continued to exercise and maintained their weight loss 3 years later (Silva et al., 2011). So, there is actual data that making this shift translates into behavior change over quite a long period of time.

If that doesn't encourage you to gain this type of motivation for yourself, I don't know what would.

What is Autonomous Motivation Really? Do You Always Have to Love What You Are Doing?

A common misconception when I talk about internal/autonomous motivation is that it means you always love everything you are doing all day every day.

Intrinsic motivation does mean that you get inherent satisfaction from the behavior.

But there are other essentially important types of Internal or Autonomous motivation too. These include Integrated and Identified motivation. Essentially, these types boil down to choosing a behavior because it's consistent with your values and the person you want to be.

5 Ways to Shift from "Should" to "Want To" (or "Choose To")

Ok Shawn, great. How do I get more autonomous motivation for a habit I want to shift? I'm so glad you asked. Here are some strategies to help with this. The good news? Sometimes it only takes one!

1. Reflect on How Its Helpful to You (Well, first make sure it is helpful, then reflect on this): If you want to get yourself to meal prep more, change how you talk to yourself about it. Instead of telling yourself you "should" do it and if you don't you're lazy, remind yourself of how it makes you feel when you do. For example, if you feel more confident, in control, and less stressed on weeks when you meal prep, remind yourself of this.

2. Evaluate How and Where the Shoulds are Coming From: There are a TONS of ways diet culture, societal pressure, and equating weight with health undermine our autonomy and feelings of control. It's ok to be mad about it, because it likely is holding you back, maybe just a little, or maybe to a great extent from true body respect and health. It makes me incredibly mad when I think about it, all the things I missed out on due to worry about dieting. Give yourself a moment, journal about it, vent to someone you trust. Just naming it and acknowledging it helps to remove it as the barrier that it has been.

3. Remind Yourself You Have a Choice. Here comes the autonomy, my friends. A lot of times the external shoulds from diet culture or society get internalized, this is "introjected motivation" (see image above) which is associated with short term change and sporadic change, at best. This often leads to the "I'll start again on Monday" thought and fits and starts of taking care of ourselves. Although we are at times fighting an uphill battle, we can reclaim autonomy by changing how we talk to ourselves.

4. Ask Yourself How You Want to Feel? Ask "How do I want to feel at the end of my day or week?" This can work for pesky work tasks you're avoiding, meal prep, any "should" task that is hanging over your head, really! Humans are motivated by emotions, not logic, so focusing on the feeling in a self supportive way can be incredibly useful.

5. Challenge Perfectionism/All-or-Nothing Thinking: This mindset is PERVASIVE in how we approach weight loss or "lifestyle change." It's also pervasive in many other areas of our culture. However, it helps no one learn, growth or become better consistently. Perfectionism is not striving for excellence. You can still strive for high goals, and by shedding perfectionism and adding in flexibility, you can actually often achieve more, without sacrificing your health.

Disclaimer/Warning: Please note, information on my site is for educational/informational purposes only and should never be used in place of medical advice. Always consult with a health care professional.

References

Silva, M. N., Markland, D., Caraca, E. V. Viera, P. N…. Teixeira, P. J. (2011). Exercise autonomous motivation predicts 3-yr weight loss in women. Medicine & Science in Sport & Exercise, 728-737.

Episode 9. Today's episode is all about how to shift a habit from a "should" to a "want to."

Free Resources Mentioned in this Episode:

23 Positive Things to do Besides Eating: A list of 23 quick ideas, with links, most 100% free!

Back on Track Pep Talk: Struggling to regain control of your eating without dieting? Grab this audio guide to walk you through the steps.

Autonomy is the Jam

As someone who worked for years trying to help people lose weight, the stats are simply not inspiring. The cool thing is, we do understand a lot about what TYPE of motivation facilitates long-term behavior change and even weight loss maintenance.

When women participating in a health program had autonomous motivation for exercise, they continued to exercise and maintained their weight loss 3 years later (Silva et al., 2011). So, there is actual data that making this shift translates into behavior change over quite a long period of time.

If that doesn't encourage you to gain this type of motivation for yourself, I don't know what would.

What is Autonomous Motivation Really? Do You Always Have to Love What You Are Doing?

A common misconception when I talk about internal/autonomous motivation is that it means you always love everything you are doing all day every day.

Intrinsic motivation does mean that you get inherent satisfaction from the behavior.

But there are other essentially important types of Internal or Autonomous motivation too. These include Integrated and Identified motivation. Essentially, these types boil down to choosing a behavior because it's consistent with your values and the person you want to be.

5 Ways to Shift from "Should" to "Want To" (or "Choose To")

Ok Shawn, great. How do I get more autonomous motivation for a habit I want to shift? I'm so glad you asked. Here are some strategies to help with this. The good news? Sometimes it only takes one!

1. Reflect on How Its Helpful to You (Well, first make sure it is helpful, then reflect on this): If you want to get yourself to meal prep more, change how you talk to yourself about it. Instead of telling yourself you "should" do it and if you don't you're lazy, remind yourself of how it makes you feel when you do. For example, if you feel more confident, in control, and less stressed on weeks when you meal prep, remind yourself of this.

2. Evaluate How and Where the Shoulds are Coming From: There are a TONS of ways diet culture, societal pressure, and equating weight with health undermine our autonomy and feelings of control. It's ok to be mad about it, because it likely is holding you back, maybe just a little, or maybe to a great extent from true body respect and health. It makes me incredibly mad when I think about it, all the things I missed out on due to worry about dieting. Give yourself a moment, journal about it, vent to someone you trust. Just naming it and acknowledging it helps to remove it as the barrier that it has been.

3. Remind Yourself You Have a Choice. Here comes the autonomy, my friends. A lot of times the external shoulds from diet culture or society get internalized, this is "introjected motivation" (see image above) which is associated with short term change and sporadic change, at best. This often leads to the "I'll start again on Monday" thought and fits and starts of taking care of ourselves. Although we are at times fighting an uphill battle, we can reclaim autonomy by changing how we talk to ourselves.

Episode 8. Today's episode is a conversation with Jenn Radke and it's a great one.

Jennifer Radke is a certified body image coach, podcast host and fat activist. Her story includes decades on a diet cycle, two bodybuilding shows and a diagnosed eating disorder.  In her coaching practice, her focus is on giving chronic dieters practical tips to being able to improve the relationship they have with their bodies and get off the diet rollercoaster.  Her podcast, Fat Girl Book Club talks to people doing cool things in body acceptance spaces about a body acceptance book.  You can find her under her business name, I Wish I Were Me on Facebook and Instagram.

Jenn's Body Liberation Journey

She shares her journey of extreme weight loss cycling for 20 years and arguably having a diet-type mentality dating back to age 5 or 6. She ended this 3 years ago and started on her body liberation journey. I didn't know her back then but she is a happy, healthy, vibrant human doing work she loves. Important work in the body acceptance space.

She reflects with us on the 2 decades of intense dieting, 18 formal diets (including Weight Watchers, Jenny Craig, and many more), 2 body building shows and an eating disorder diagnosis.

What Motivates Change? Emotions, not Information.

She talks about what made her eventually stop. Jenn and I reflected on the fact that although she loves books, research and information, that alone was not enough to get her to change. She had to have what she calls a "rock bottom moment" where her weight loss coach questioned her commitment to her "self-care" when she took two weeks to care for her uncle who was in hospice.

She had read Health at Every Size by Dr. Lindo Bacon, but it was that moment that really made the difference for her.

Deconstructing and Redefining "Health"

I can decide what does the value of health mean for me.Jenn Radke

Jenn gives us the insider's view of what it was like to try to reframe and reconstruct what health meant to her.

She talked about practical things she did like writing down all the things she gave to dieting, including all of the mental, emotional, and cognitive energy it took from her for years. She reflects on this if she is tempted to diet again.

Only the Person in the Body Knows

We discussed how most of the time, with the exception of more extreme behaviors, typically only the person in the body knows if their behavior is healthy or not.

The judgment of this can go both ways. Someone can look at someone who is exercising 4 times per week and say "oh that's really healthy" or even in the other extreme, Jenn talks about how occasionally in the body acceptance space people can assume this means someone is still in the "diet mentality."

We clarify that the true definition of autonomy is someone that's known by the person in the body alone and how the exact same behavior can be autonomous or controlled (by the diet mentality or "shoulds") and it's important not to judge a book by it's cover (in many, many ways).

Practical Ways to Improve Your Body Image

Jenn gives us some really practical strategies for improving body image. These include:

Reflecting on your dieting triggers. Being aware of what these are (e.g., might be seeing a picture of yourself, or noticing you gained weight) can help you be prepared and know you have choices when you get that urge. Weight loss dieting isn't the only option.Curating your social media. Become aware of the messages you consume. Avoid following folks who make you feel bad about yourself.Buying comfortable clothes.

Take Home Message: It's Great Over Here!

Jenn exudes vibrancy and energy. Again, I didn't know her when she was dieting, but based on her story I venture a guess that she's bringing so much more of her authentic self to the world now that she isn't focused on rigid calorie counting and plan following and achieving a certain body in the name of "health."

She glows when she talks about pursuing her dreams and goals and helping others do the same.

I'm grateful for her message and sharing her story with us today!

Disclosure: This page includes affiliate links meaning that I get a commission if you decide to make a purchase through my links, at no cost to you. I have not received any money to promote or review these products.

Disclaimer: This blog and podcast is for informational and educational purposes only. It is not a substitute for individual professional advice or treatment, including medical or mental health advice. It does not constitute a provider patient relationship.

Episode 8. Today's episode is a conversation with Jenn Radke and it's a great one.

Jennifer Radke is a certified body image coach, podcast host and fat activist. Her story includes decades on a diet cycle, two bodybuilding shows and a diagnosed eating disorder.  In her coaching practice, her focus is on giving chronic dieters practical tips to being able to improve the relationship they have with their bodies and get off the diet rollercoaster.  Her podcast, Fat Girl Book Club talks to people doing cool things in body acceptance spaces about a body acceptance book.  You can find her under her business name, I Wish I Were Me on Facebook and Instagram.

Jenn's Body Liberation Journey

She shares her journey of extreme weight loss cycling for 20 years and arguably having a diet-type mentality dating back to age 5 or 6. She ended this 3 years ago and started on her body liberation journey. I didn't know her back then but she is a happy, healthy, vibrant human doing work she loves. Important work in the body acceptance space.

She reflects with us on the 2 decades of intense dieting, 18 formal diets (including Weight Watchers, Jenny Craig, and many more), 2 body building shows and an eating disorder diagnosis.

What Motivates Change? Emotions, not Information.

She talks about what made her eventually stop. Jenn and I reflected on the fact that although she loves books, research and information, that alone was not enough to get her to change. She had to have what she calls a "rock bottom moment" where her weight loss coach questioned her commitment to her "self-care" when she took two weeks to care for her uncle who was in hospice.

She had read Health at Every Size by Dr. Lindo Bacon, but it was that moment that really made the difference for her.

Deconstructing and Redefining "Health"

I can decide what does the value of health mean for me.Jenn Radke

Jenn gives us the insider's view of what it was like to try to reframe and reconstruct what health meant to her.

She talked about practical things she did like writing down all the things she gave to dieting, including all of the mental, emotional, and cognitive energy it took from her for years. She reflects on this if she is tempted to diet again.

Only the Person in the Body Knows

We discussed how most of the time, with the exception of more extreme behaviors, typically only the person in the body knows if their behavior is healthy or not.

The judgment of this can go both ways. Someone can look at someone who is exercising 4 times per week and say "oh that's really healthy" or even in the other extreme, Jenn talks about how occasionally in the body acceptance space people can assume this means someone is still in the "diet mentality."

We clarify that the true definition of autonomy is someone that's known by the person in the body alone and how the exact same behavior can be autonomous or controlled (by the diet mentality or "shoulds") and it's important not to judge a book by it's cover (in many, many ways).

Practical Ways to Improve Your Body Image

Jenn gives us some really practical strategies for improving body image. These include:

* Reflecting on your dieting triggers.